Consequences of Osteoporosis
Although sufficient force (e.g., when moving at speed or falling from a height) will cause anyone to break a bone, if you have osteoporosis, broken bones are more likely to occur after even a simple fall.
If you are told you have ‘established’ osteoporosis, this means you are someone who has been diagnosed with osteoporosis on a scan and you also have fractures caused by osteoporosis. Bones affected by osteoporosis are not in themselves painful but the broken bones that may result can cause pain and other problems.
A broken wrist can be the first indication that you have osteoporosis. Wrist fractures in women often occur soon after the menopause and typically occur following a fall, as people commonly put out an arm in an attempt to break their fall. Healthy bones should be able to withstand a simple fall so a broken bone in these circumstances, without any other disease, is an indication that there may be underlying osteoporosis.
Fractures that occur because of reduced bone strength are described as ‘fragility fractures’ and many of these will be caused by osteoporosis.
The most common site for a hip to break is across the top of the thigh bone (fractured neck of femur). If you have broken your hip as a result of osteoporosis, you are most likely to be in your late seventies or eighties, although you may be younger. This type of hip fracture typically occurs as the result of a fall. Like any fracture, a broken hip is painful and has an immediate impact on day-to-day living. Most people who break a hip are admitted to hospital and require an operation. If you are fit and well before your hip breaks, you should be able to look forward to independent living with appropriate physiotherapy and help from social services if you need it. As you get older, you may also be coping with other medical conditions, and making an uncomplicated recovery from an operation to mend your hip and getting back to your own home may be less easy. This is why it’s so important to try to do everything possible to prevent a hip fracture happening in the first place.
Fractures due to osteoporosis of the bones in the spine (vertebrae) usually occur in the lumbar (lower) or thoracic (middle) areas of the spine. They are often referred to as spinal or vertebral fractures. Bones become squashed or compressed because of their reduced strength. Sometimes they are referred to as ‘crush’, ‘collapsed’ or ‘wedge’ fractures, depending on which part of the vertebra is affected. ‘Compression fracture’ is a good way of describing these fractures. Back pain is the most frequent symptom of a spinal fracture; however, the degree of pain varies in different people, with many having no symptoms at all. Why this is so is not clear. In most people, spinal fractures heal over a period of 6–12 weeks and back pain if present tends to decrease during this time. However pain may persist for a longer period, particularly if you have had more than one fracture.
If you ‘break your back’ does it mean you will be paralysed?
No. The vast majority of fractures that occur in people with osteoporosis following minor levels of trauma are ‘stable’ and do not interfere with the spinal cord or result in paralysis or loss of sensation, except in very unusual cases.
How does osteoporosis cause height loss and spinal curvature (‘dowager’s hump’)?
Although spinal bones heal, they do not return to their original shape, and this may result in height loss and spinal curvature. If fractures in your spine have healed in a flattened or wedge shape, this can cause the spine to tip forwards, resulting in an outward curve (kyphosis) in your back, and height loss. Sometimes these changes can result in a lack of space for your internal organs so other problems such as breathlessness, a protruding abdomen, indigestion or stress incontinence, can occur. Changes in posture due to osteoporosis can affect how you feel about how you look (your body image). If you feel distressed and frustrated by the changes in your body shape and especially if buying suitable clothes has become difficult, our booklet on clothing and body image may be useful.
If you are someone with very fragile bones, a fracture of one or more of the spinal bones can occasionally occur after an awkward movement such as reaching up to a cupboard. Unlike hip fractures, which happen when you fall, spinal fractures can occur following everyday activities of daily living such as bending or stooping.
This understandably can make you feel very frightened of further fractures and finding ways to continue normal activities with confidence will be important. It is vital to remember that not everyone has fractures that cause symptoms and disability. And, if you do experience such debilitating fractures, there are many things that can be done to help.
Other bones such as the humerus (upper arm), ribs or pelvis may break if they are fragile but the wrist, spinal bones and hip are the most common places for fractures to occur.
I have heard you can die from osteoporosis, which has frightened me. Can you explain?
Osteoporosis does not itself result in an increased risk of dying. As explained, the changes that occur within the bones to make them less strong, give you no symptoms at all, and fractures in themselves are not fatal. However, breaking bones, especially your hip when you are much older, can result in you becoming more frail and less well and you may find it much harder to get back to the same level of fitness and independence you had before. Statistically, this reduces your life expectancy compared to someone who hasn’t broken their hip. It isn’t the fracture itself but being less well following the fracture, coupled with the many other medical conditions that older people have to cope with, as well as having to have an operation, that can result in reduced life expectancy. Keeping fit and active into old age, as well as good treatment in hospital and after you are discharged, will greatly reduce the chance offractures affecting your life span.
There are a number of less common types of osteoporosis and related conditions...